HomeMy WebLinkAboutProject Completion Affidavit - River Walk Lighting Proj No 117-080 - TGB Unlimited dba ST Bancroft1316 COUNTY-0 J'Y 13011,I)ING
227 W. JEFFEMSON BOULEIVARD
Sou'ri-i BEND. INDIANA 46601-1830
February 13, 2018
Scott Bancroft
TGB Unlimited dba S/T Bancroft Electric
25020 TN-2
South Bend, IN 46619
PHOW:1 574/235-9251
FAX 574/ 235-9171
RE: Project Completion Affidavit — River Walk Lighting — Project No. 117-080
Dear Mr. Bancroft:
The Board of Public Works, at its meeting held on February 13, 2018, approved the Project
Completion Affidavit for this project in the amount of $47,990.
A copy of the Project Completion Affidavit is enclosed for your records.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
Linda M. Martin, Clerk,
Enclosure
c: Toy Villa, Engineering
GARY A. GILOT SUZANNA M, FRITZBERG ELIZAK'ni A. MMZADIK JAW.,s A. MUELLER TIffiRESE J. DORAU
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
PROJECT COMPLETION AFFIDAVIT
PROJECT NAME -River Walk Subdivision Street Lighting
PROJECT NO 117-080 FINAL COST $47,990.00
CONTRACT SIGNED 9/12/2017 MAINTENANCE AGREEMENT ENIDS
PROJECT DESCRIPTION Install liqhtinq foundations, conduit, and TESCO service within the River Walk subdivision,
WITNESSETH:
The work under the above contract between the City of South Bend and the undersigned contractor having been completed,
the City of South Bend, its officials and agents are hereby released from all claims, and demands whatsoever arising under or
by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City
of South Bend which were a part of the above Contract.
Executed this day of.` 201_2L TGB Unlimited d/b/a SfT Bancroft Electric
Nw Company Name
25020 IN-2
Company Address
Printed Narfre South Bend, IN 46619
City, State, Zip
WITNESSESS,:
Before the un�- rsigned Notary Public in and for said country and state, personally appeared'
and acknowledged his/her signature to the above Project Completion Affidavit on
the .201 �vLYNN SARTI f P0,1/,/
of Indian
Notary Public, Stato
i Oporto C
na 6MfPlq*gRAMiWExpirO5 -1QV)"(',,
%
oullty
Notary Sig ,y
41nnwa'6
Line 18, 2029
Printed Name County of Residence J_z,�fi, ro
If the C,ontractola corpor n, the following certificate will be executed.
C, XJ
1)( 7T
C, o orc certify that I am Secretary of the Corporation executing this release; that
11-1 t.,vy1(.',Vn1-+' , who signed this release on behalf of the contractor was then
. ....... , hS 10 eil I- of said Corporation; that said release was duly signed for and on behalf of said z,
XC por atiby Authority of its
It . 'overning body, and is within the scope of corporate powers:
Secretary's Signature —
«2:4 Corporate Seal
Printed Name
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable thr fin I approval and we recommend to the Board of Public Works that it be ordained so.
Date:
Construction ttger
BOARD F PUBLIC I ORKS APPROVAL Date: PW
, U-5,
lo Al
-- Gary A. Gilot,'President --sdzann, a M. Ed(zberg, gerrifer Elizabeth A. aradik, Member
zl - -
Therese S—borau,rrnwr James A. Mueller, Member -"a M. Martin, Clerk
Final Waiver of Lien
Stale of Jndlana, County of )SE101"I SS:
I (�'I�tvl being duly sworn that lielshe Is the
(Name of Officer) ('Title)
Of hav ng contracted with
(Contractor) (Owner)
to furnish cettain materials, and/or labor as follows,,
for a project known as
located at
and owned by
S c')
and does hereby further State on the behalf of the aforementioned subcontraotor/supplier:
(PARVAL WAIVER) that there is due from the Contractor the sum of
Dollars 0 1
D receipt of which is hereby aolmowledged; or
El the payment of which lies been promised as the Sole consideration for this Affidavlt and Final Waiver of Lien -which is given
solely with respect to said amount, and which waiver Shall bo effective. only upon receipt of payment thereof by the
undersigned;
(MALWAIVER)tbalth, al balance due froin the co itractor Is the sum of
j JJr� )� _ vc.a huLC1,vcJ y)
d t J d Z"3'99'5,o
El receipt of which Is hereby acknowledged; or
the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall
become effective only'upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the owner of said premises, any and all liens or claims whatsoever
on the above -described property and Improvements thereon an account of labor or material or bath,
furnished b the undersigned
thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a
Ron on account of any work perfornied or material furnished to the undersigned for said project and within the scope of this Affidavit
and Waiver of Lien.
By
STATE OF INDMNA (Fhm) (Authorized Representative)
SS.
ST. JOSEPH COUNTY
Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared
and aftowledged the execution of the foregoing AffidavIt. and Waiver of Lion,
IN WIT ESS WHEREOF, I have hereunto subscribed my name and affixed my officink"se I op,° day of
200 L2(L)
NoUbl
pfros:
My Conimfsalon EX C)011
Residing in county,
Notary.Publio Nome
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
01/20/2018
Department
Public Works
Name
Toy Villa
Division/Bureau
Engineering
BPW Date
02/13/2018
Phone Extension
5920
om
Controller
Purchasing
L_J Agreement
F-1 Professional Services
F-1 Bid Opening
F-1 Quote Opening
F Change Order No.
F1 Ease/Encroach.
F-1 Other:
New Vendor
MBE/WBE Contractor
n Attorney Name:
E] Controller review is required for all Contracts $5,0010.00 or more and
greater than one year in length per the City Purchasing Policy
El
I I Contract
N
FS M TIM
n Bid Award E:1 Req. to Advertise
Quote Award
C/O & PCA No. PCA
Traffic Control:
Required Information
TGB Unlimited (dba) S/T Bancroft Electric
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Addendum
El Title Sheet
U Yes M No H If Yes, Approved by
Purchasing
LJ MBE LJ WBE
El No El Yes Name of Company
River Walk Lighting
117-080
COIT
404.0602.431.22A0
$47,990.00
ect Closeout
H Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Amount of F-11 increase $
D Decrease $
Previous Amount $
Current Percent of Change: %
New Amount $
Total Percent of Change: %
Copy
Original
11
El
F-1
F-1
n
El